Evaluation of the TG-43 formalism for intraoperative radiotherapy dosimetry in glioblastoma treatment
Abstract
Background: Intraoperative radiation therapy (IORT) using the INTRABEAM system has shown promise in glioblastoma treatment. However, accurate dosimetry remains challenging due to the low-energy photons used and the heterogeneity of tissues in the brain. Current clinical practice relies on the TARGIT method, but more robust approaches, including the TG-43 formalism and Monte Carlo (MC) simulations, warrant investigation for potential improvements in dose calculation accuracy.
Purpose: To evaluate the TG-43 dosimetry formalism for IORT dose calculations in glioblastoma treatment using the INTRABEAM system, comparing it with the TARGIT method and MC simulations.
Methods: We analyzed the dose distributions in 20 patients from the INTRAGO trial. The TG-43 formalism was validated against MC simulations in water ( MCw${\rm MC}_{\rm w}$ ) using global/local dose differences and gamma analysis (1%/1mm). Organ at risk (OAR) doses were calculated using TG-43, TARGIT, MCw${\rm MC}_{\rm w}$ , and MC in heterogeneous media ( MChet${\rm MC}_{\rm het}$ ). Combined IORT and external beam radiotherapy (EBRT) doses were evaluated.
Results: TG-43 showed good agreement with MCw${\rm MC}_{\rm w}$ , with a 98.0% gamma pass rate. The mean global dose difference was 0.07% ±$\pm$ 0.29%, with TG-43 slightly overestimating dose compared to MCw${\rm MC}_{\rm w}$ . For OAR dose comparisons using TG-43 as reference, TARGIT underestimated doses by 0.1%-1.7%, while MChet${\rm MC}_{\rm het}$ showed larger…
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